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Nutrition Therapy in Shock

Authors
  • Lollar, Daniel1
  • Collier, Bryan2
  • 1 Carilion Roanoke Memorial Hospital, Virginia Tech/Carilion School of Medicine, 1906 Belleview Avenue, Medical Education Building, Suite 330, Roanoke, VA, 24014, USA , Roanoke (United States)
  • 2 Carilion Roanoke Memorial Hospital, Virginia Tech/Carilion School of Medicine, 1906 Belleview Avenue, Medical Education Building, Suite 329, Roanoke, VA, 24014, USA , Roanoke (United States)
Type
Published Article
Journal
Current Surgery Reports
Publisher
Springer US
Publication Date
Oct 27, 2016
Volume
4
Issue
12
Identifiers
DOI: 10.1007/s40137-016-0161-2
Source
Springer Nature
Keywords
License
Yellow

Abstract

Purpose of ReviewThe dictum of surgical metabolism describing the ebb and flow of nutrients after injury can be seen as an alteration of the hormonal milieu. Shock, therefore, is a state by which nutrients are delivered only by diffusion, while shock resolution is marked by a transition to nutrient diversion into essential and salvage pathways. The gut requires significant cardiac output at rest, and this demand increases during enteral feeding. The mismatch between supply and demand can be exacerbated during the shock state, or, paradoxically, improved.Recent FindingsEnteral nutrition (EN) should be initiated within 24–48 h of the resolution of the shock state, and monitoring for feeding intolerance should be continued throughout recovery. Enteral formulas with additive amino acids or antioxidants have mixed reviews; however, “immunonutrition” is well supported.SummaryCareful attention to nutritional assessment and provision during the earliest phases of critical care, specifically shock, provides the best outcomes.

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